The first step to get to that diagnosis is usually to do a nerve conduction study. A nerve conduction study, if carefully reviewed and fulfilled the demyelinating criteria, then you can call the neuropathy as a demyelinating neuropathy. And the reason we like to do that, because it really narrows our differential diagnosis versus axonal neuropathy that has a much larger, much wider differential diagnosis...
The first step to get to that diagnosis is usually to do a nerve conduction study. A nerve conduction study, if carefully reviewed and fulfilled the demyelinating criteria, then you can call the neuropathy as a demyelinating neuropathy. And the reason we like to do that, because it really narrows our differential diagnosis versus axonal neuropathy that has a much larger, much wider differential diagnosis. Plus the differential diagnosis of demyelinating neuropathy, especially the acquired demyelinating neuropathy, can result in treatment and improvement in symptoms. So that’s why it’s very important to reach that diagnosis. So first step is do the nerve conduction study and take a very good history. So you get a good history you make sure this is an acquired versus an inherited process because if it’s an inherited process obviously the workup is different. If it’s acquired then you’re thinking very strongly about CIDP, chronic inflammatory demyelinating polyneuropathy, which is a treatable condition and can improve with treatment. Obviously, you want to also make sure there’s no CIDP mimics. So things that look like CIDP but actually are something different, such as POEMS or those related to neurofascin or contactin antibody with IgG4 or those that are related with IgM monoclonal gammopathy. But once you rule those out, then you’re dealing with CIDP, which is a treatable condition, and you really usually expect improvement in treatment. Some of the challenges are really doing an adequate nerve conduction study. So you have to be really careful when doing the nerve conduction study, making sure your limb temperature is correct, making sure your measurements are correct, and making sure you’re not over-interpreting or over-relying on the nerve conduction study. So you really have to look at the whole picture, at the clinical presentation of the patient, the findings on exam, and be careful with your nerve conduction study when doing them to make sure that they really fulfill the criteria for demyelination versus you’re more dealing with an axonal type of neuropathy.
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